Blue Cross Medicare Advantage (HMO)℠ Members Transitioning to HealthSpring℠ Plan for 2027

By December 31, 2026: (1) Billing team must identify all current BCBSOK Medicare Advantage HMO members in the practice by reviewing ID cards and patient records. (2) Verify your practice's network participation status with HealthSpring—contact Provider Relations or HealthSpring directly to confirm contracted status. (3) If contracted with HealthSpring, update billing software and patient records to accept and process new HealthSpring ID cards and member ID numbers (including alpha prefix) effective January 1, 2027. (4) Update all eligibility verification processes in Availity Essentials or your preferred vendor to recognize HealthSpring member IDs. (5) If NOT contracted with HealthSpring, create a notification process to alert front desk and clinical staff that these members' services may not be covered (except emergencies); staff should direct members to HealthSpring provider directory. (6) Review and update billing workflows to follow HealthSpring's utilization management requirements, prior authorization processes, and claim submission procedures starting January 1, 2027. (7) Train front desk staff to request new HealthSpring ID cards at all 2027 appointments and verify eligibility before services. Failure to transition to HealthSpring billing processes will result in claim denials for non-emergency services provided by out-of-network providers.